More than Half of U.S Physicians Recommend at Least One Complementary Health Approach to Patients

A new study has shown that more than half (53.1%) of office-based physicians in the U.S., across specialty areas, recommended at least one complementary health approach (CHA) to their patients during the previous 12 months, with female physicians (63.2%) more likely to recommend a CHA than male physicians (49.3%). This unique study, JACM, The Journal of Alternative and Complementary Medicine, found physician’s sex, race, specialty, and U.S. region to be significant predictors of CHA recommendation.

The article, “U.S. Physician Recommendations to Their Patients About the Use of Complementary Health Approaches” was coauthored by Barbara Stussman and Richard Nahin, PhD, MPH, National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, and Patricia Barnes and Brian Ward, PhD, National Center for Health Statistics, Hyattsville, MD. The data are based on the 2012 Physician Induction Interview of the National Ambulatory Medical Care Survey (NAMCS PII).

Primary Findings on Complementary Health

The authors anticipate that their findings will “enable consumers, physicians, and medical schools to better understand potential differences in use of CHAs with patients.”

  • The researchers analyzed recommendations by physicians to their patients for any CHA and for individual approaches, including massage therapy, herbs/nonvitamin supplements, chiropractic/osteopathic manipulation, yoga, acupuncture, and mind-body therapies.
  • Overall, massage therapy was the most commonly recommended CHA, followed by chiropractic/osteopathic manipulation, herbs/nonvitamin supplements, yoga, and acupuncture.
  • The analysis also looked at physician specialty area, including general/family practice physicians, psychiatrists, OB/GYNs, and pediatricians, and their likelihood of recommending any or a specific CHA.

“It is remarkable that these 2012 data pre-date the systematic inclusion of complementary and integrative approaches in pain and opioid-related guidelines and reports from the Joint Commission, National Academy of Medicine, American College of Physicians, Food and Drug Administration, and others in the 7 years since. The data likely significantly understate present level of recommendations of complementary health practices by physicians,” said JACM Editor-in-Chief John Weeks, and monthly columnist for Today’s Practitioner.

There were 5622 physicians who provided data for these analyses, representing 338,627 physicians in the United States. Among non-federal, office-based U.S. physicians, 72.3% were male and 27.7% were female (Table 1). Excluding the “other” category, the most commonly observed specialty for male physicians was general/family practice (16.0%), followed by internal medicine (13.0%). For female physicians it was general/family practice (20.0%) and pediatrics (19.7%). The majority of physicians (94.1%) were MDs and three-quarters (75.2%) attended U.S. medical schools. Most physicians (92.7%) practiced in MSAs. Approximately 35.2% practice in the South, 24.4% in the West, 21.5% in the Northeast and 18.9% in the Midwest.

Female physicians recommended CHAs at a higher rate than male physicians (63.2% vs. 49.3%, respectively), even when controlling for additional characteristics (See FIGURE 1). Female physicians were approximately twice as likely to recommend each individual therapy, except chiropractic/osteopathic manipulation. These findings confirm and expand upon prior studies that found female physicians more likely to talk to patients about CHAs or recommend CHAs. Another factor is that previous studies have consistently found higher usage rates of CHAs among U.S. women than among men. Likewise, physicians who report personal usage of CHAs are more likely to recommend CHAs to patients.

FIGURE 1

Prevalence of recommendations for complementary health approaches among office-based physicians, by physician’s sex: United States, 2012. 95% Korn–Graubard CIs are shown. Any CHA includes the following: massage therapy, chiropractic or osteopathic manipulation, herbs and other nonvitamin supplements, yoga, acupuncture, mind–body therapies (such as guided imagery, meditation, and progressive muscle relaxation, not including prayer), biofeedback or hypnosis, homeopathic treatment, and naturopathic treatment. For each CHA and physician’s sex, Wald Chi-square tests were significant (p < 0.05). CHA, complementary health approach; CI, confidence interval. Source: National Ambulatory Medical Care Survey Physician Induction Interview, 2012 (n = 5622).

FIGURE 2

Prevalence of recommendations for complementary health approaches among office-based physicians, by physician’s medical specialty: United States, 2012. 95% Korn–Graubard CIs are shown. Any CHA includes the following: massage therapy, chiropractic or osteopathic manipulation, herbs and other nonvitamin supplements, yoga, acupuncture, mind–body therapies (such as guided imagery, meditation, and progressive muscle relaxation, not including prayer), biofeedback or hypnosis, homeopathic treatment, and naturopathic treatment. For each CHA and physician’s medical specialty, Wald Chi-square tests were significant (p < 0.05). CHA, complementary health approach; CI, confidence interval; OB/GYN, obstetrics and gynecology. Source: National Ambulatory Medical Care Survey Physician Induction Interview, 2012 (n = 5622).

This study is significant because it is more “comprehensive than previous national studies in that it examined recommendations by several medical specialties,” the researchers noted.

When considering why CHA approaches were being offered, researchers made the following conclusions:

  • General/family practitioners recommend chiropractic/osteopathic manipulation most frequently could be related to high rates of health insurance coverage for this approach in the general population and in the Medicare population;
  • Primary care physicians’ high use of and referral rates for complementary approaches for patients with relatively stable chronic musculoskeletal problems such as back pain, headache, or pain management;
  • The high rate of recommendations for mind–body therapies by psychiatrists may be due to findings in previous research that confirms benefit of relaxation techniques, mediation, and mindfulness-based stress reduction for psychological conditions such as post-traumatic stress disorder, anxiety, and depression;
  • In addition, that pediatricians recommend herbs and non-vitamin supplements most commonly may be explained by the relatively high use of fish oil, melatonin, probiotics, and echinacea in children.

Overall, DOs are more likely than MDs to recommend any CHA. Also, physicians practicing in the West were more likely to recommend every CHA than physicians practicing in the South is consistent with previous national data on usage in the general population.

Conclusion/ “This study analyses show that physicians often recommend CHAs, with 53.1% of office-based U.S. physicians recommending at least one to their patients in the past 12 months. Recommendation rates were higher among female physicians than among male physicians and varied by medical specialty. General/family practitioners and internists recommended CHAs at higher rates than pediatricians, and more than half of psychiatrists recommended mind–body therapies, compared with <30% of physicians from other specialties. Understanding practice patterns of U.S. physicians related to recommendations for CHAs, and their differences across medical specialties and physician sex, could inform consumers, physicians, and medical schools.”

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Source: Barbara J. Stussman, Richard R. Nahin, Patricia M. Barnes, and Brian W. Ward.The Journal of Alternative and Complementary Medicine.ahead of printhttp://doi.org/10.1089/acm.2019.0303 Online Ahead of Print: December 2, 2019